Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study
Jonathan Branney1, Alan C Breen2
1Institute of Musculoskeletal Research & Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK ; The School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK.
Chiropractic & Manual Therapies
|July 19, 2014
Summary
Spinal manipulation may increase inter-vertebral range of motion (IV-RoM) in the cervical spine, but this mechanical change did not improve patient-reported outcomes for neck pain. Palpation was unreliable for detecting restricted motion.
Area of Science:
- Biomedical Engineering
- Orthopedics
- Physical Therapy
Background:
- Spinal manipulation is a common treatment for nonspecific neck pain.
- Its mechanism is hypothesized to involve improving inter-vertebral range of motion (IV-RoM).
- Measuring IV-RoM and linking it to clinical outcomes remains challenging.
Purpose of the Study:
- To quantify changes in cervical spine flexion and extension IV-RoM after spinal manipulation.
- To investigate the relationship between IV-RoM changes and clinical outcomes.
- To compare palpation with quantitative fluoroscopy (QF) for detecting hypomobile segments.
Main Methods:
- Thirty patients with neck pain and 30 controls underwent QF for IV-RoM measurement (C1-C6) at baseline and 4 weeks.
- Patients received up to 12 spinal manipulations and completed outcome questionnaires.
- QF accuracy, repeatability, and minimal detectable changes (MDC) were established.
Main Results:
- QF demonstrated high accuracy and repeatability for IV-RoM measurement.
- No significant correlation was found between IV-RoM increases above MDC and clinical outcomes.
- A modest correlation existed between the number of manipulations and increased IV-RoM at specific spinal levels.
- Palpation showed no agreement with QF in identifying hypomobile segments.
Conclusions:
- Cervical sagittal IV-RoM did not differ between patients and controls.
- Spinal manipulation showed a dose-response effect on segmental IV-RoM, indicating a mechanical impact.
- Patient-reported outcomes were not associated with observed changes in IV-RoM.
